Association of Surgical Ward Nurse Staffing With Postoperative Mortality and Failure to Rescue
4 affiliations
- 1Department of Surgery University of Auckland Auckland New Zealand
- 2Department of Surgery Middlemore Hospital Auckland New Zealand
- 3Department of Surgery Mayo Clinic Rochester Minnesota USA
- 4Department of Anaesthesia & Perioperative Medicine Auckland City Hospital Auckland New Zealand
Abstract
Introduction: Postoperative mortality commonly follows complications that are not prevented, recognised or managed effectively. Ward‐based nursing care is central to surveillance, escalation and rescue, but population‐level evidence using shift‐level staffing data is limited. This national population‐based cohort study examined the association between surgical ward nurse staffing and postoperative outcomes.
Methods: Adults aged 18 years or older undergoing inpatient surgery under general or neuraxial anaesthesia in public hospitals in Aotearoa New Zealand between 2022 and 2024 were included. Prospectively recorded TrendCare staffing data were linked to administrative health datasets. The exposure was shift‐level staffing variance, defined as the difference between required and available nursing care hours on surgical wards in the treating hospital during admission. The primary outcome was 90‐day postoperative mortality. Secondary outcomes were postoperative complications and failure to rescue.
Results: The cohort included 202 428 patients undergoing 223 415 surgical admissions. Within 90 days, 6296 admissions resulted in death (2.8%). Complications occurred in 41 722 admissions (18.7%), with failure to rescue in 15.1%. Of 281 147 surgical ward shifts, 122 186 (43.5%) were understaffed. After adjustment, each one‐nurse reduction in staffing per shift was associated with higher odds of mortality (aOR: 1.13, 95% CI: 1.07–1.18), complications (aOR: 1.07, 95% CI: 1.05–1.10) and failure to rescue (aOR: 1.07, 95% CI: 1.00–1.14). Modelling estimated that correcting observed staffing deficits was associated with 182 fewer deaths annually.
Conclusion: Lower surgical ward nurse staffing was associated with increased postoperative mortality, complications and failure to rescue. Nurse staffing is a modifiable system factor associated with postoperative safety and should be prioritised to improve surgical outcomes.
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BibTeX
@article{wells2026association,
title = {{Association of Surgical Ward Nurse Staffing With Postoperative Mortality and Failure to Rescue}},
author = {Cameron I. Wells and Kate Henderson and Chris Varghese and Greg O'Grady and Luke Boyle and Ian P. Bissett and Doug Campbell},
journal = {Anz Journal of Surgery},
year = {2026},
month = aug,
doi = {10.1111/ans.70903},
url = {https://doi.org/10.1111/ans.70903},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Association of Surgical Ward Nurse Staffing With Postoperative Mortality and Failure to Rescue
AU - Cameron I. Wells
AU - Kate Henderson
AU - Chris Varghese
AU - Greg O'Grady
AU - Luke Boyle
AU - Ian P. Bissett
AU - Doug Campbell
PY - 2026
DA - 2026/08/13
JO - Anz Journal of Surgery
DO - 10.1111/ans.70903
UR - https://doi.org/10.1111/ans.70903
AB - Introduction: Postoperative mortality commonly follows complications that are not prevented, recognised or managed effectively. Ward‐based nursing care is central to surveillance, escalation and rescue, but population‐level evidence using shift‐level staffing data is limited. This national population‐based cohort study examined the association between surgical ward nurse staffing and postoperative outcomes. Methods: Adults aged 18 years or older undergoing inpatient surgery under general or neuraxial anaesthesia in public hospitals in Aotearoa New Zealand between 2022 and 2024 were included. Prospectively recorded TrendCare staffing data were linked to administrative health datasets. The exposure was shift‐level staffing variance, defined as the difference between required and available nursing care hours on surgical wards in the treating hospital during admission. The primary outcome was 90‐day postoperative mortality. Secondary outcomes were postoperative complications and failure to rescue. Results: The cohort included 202 428 patients undergoing 223 415 surgical admissions. Within 90 days, 6296 admissions resulted in death (2.8%). Complications occurred in 41 722 admissions (18.7%), with failure to rescue in 15.1%. Of 281 147 surgical ward shifts, 122 186 (43.5%) were understaffed. After adjustment, each one‐nurse reduction in staffing per shift was associated with higher odds of mortality (aOR: 1.13, 95% CI: 1.07–1.18), complications (aOR: 1.07, 95% CI: 1.05–1.10) and failure to rescue (aOR: 1.07, 95% CI: 1.00–1.14). Modelling estimated that correcting observed staffing deficits was associated with 182 fewer deaths annually. Conclusion: Lower surgical ward nurse staffing was associated with increased postoperative mortality, complications and failure to rescue. Nurse staffing is a modifiable system factor associated with postoperative safety and should be prioritised to improve surgical outcomes.
SN - 1445-1433
SN - 1445-2197
ER -